Radiotherapy after Prostatectomy

2002 ◽  
Vol 88 (6) ◽  
pp. 445-452 ◽  
Author(s):  
Giuseppe Sanguineti ◽  
Paola Franzone ◽  
Laura Culp ◽  
Michela Marcenaro ◽  
Salvina Barra ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
Adjuvant Radiotherapy ◽  
Potential Role ◽  
Specific Antigen ◽  
Salvage Treatment ◽  
Salvage Radiotherapy ◽  
Risk Of Failure

Aims and background The role of radiotherapy after prostatectomy is controversial. This paper tries to give some guidelines for everyday practice through an analysis of literature data. Methods The potential role of radiotherapy in the adjuvant and salvage setting is discussed. We also report and interpret available literature data for both settings. Results As regards an increase in or detectable prostate-specific antigen (PSA) after radical prostatectomy, about 40–50% of patients are rendered bNED with local salvage radiotherapy, but only 10–50% are long-term (5 years) biochemically controlled. A timely salvage treatment is crucial to optimize control probability. As regards adjuvant radiotherapy for undetectable postoperative PSA in patients at high risk of failure as judged on pathology, results are more encouraging. Recent data report bNED rates ≥70% at 5 years. Conclusions Although results are far from satisfactory, salvage radiotherapy should be considered for every patient with an increased or detectable PSA after surgery. Adjuvant radiotherapy seems preferable to salvage radiotherapy for patients at high (>30%) risk of failure.

Long-term oncologic outcomes of neoadjuvant chemohormonal therapy followed by radical prostatectomy for patients with clinically localized, high-risk prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 153-153
Author(s):  
Jonathan L Silberstein ◽  
Stephen A Poon ◽  
Daniel Sjoberg ◽  
Andrew J. Vickers ◽  
Aaron Bernie ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Oncologic Outcomes ◽  
Chemohormonal Therapy ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

153 Background: To determine long-term oncologic outcomes of radical prostatectomy (RP) after neoadjuvant chemo-hormonal therapy for clinically localized, high-risk prostate cancer. Methods: In this phase II multicenter trial of patients with high-risk prostate cancer (prostate-specific antigen greater than 20ng/ml, Gleason greater than or equal to 8, or clinical stage greater than or equal to T3), androgen deprivation therapy (goserelin acetate depot) and paclitaxel, carboplatin and estramustine were administered prior to RP. We report the long-term oncologic outcomes of these patients and compared them to a contemporary cohort who met oncologic inclusion criteria but received RP only. Results: Thirty four patients were enrolled in this study and followed for a median of 13.1 years. Within 10 years most patients experienced biochemical recurrence (BCR-free probability= 22%; 95% CI 10%, 37%). However the probability of disease-specific survival at 10 years was 84% (95% CI 66%, 93%) and overall survival was 78% (95% CI 60%, 89%). The chemohormonal therapy group had higher-risk features than the comparison group (N=123 patients) with an almost doubled risk of calculated preoperative 5-year BCR (69% vs 36%, p<0.0001). After adjusting for these imbalances the CHT group had trends toward improvement in BCR (0.76, 95% CI 0.43, 1.34; p=0.3) and metastasis free survival (0.55, 95% CI 0.24, 1.29; p=.2) although these were not significant. Conclusions: Neoadjuvant chemohormonal therapy followed by RP was associated with lower observed rates of BCR and metastasis compared to a prostatectomy only group; however these results were not significant. Because this treatment strategy has known harms and unproven benefit, this strategy should only be instituted in the setting of a clinical trial.

Natural history of an immediately detectable PSA following radical prostatectomy: A description of a contemporary cohort.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 356-356
Author(s):  
Peter Eoin Lonergan ◽  
Samuel L. Washington ◽  
Janet E. Cowan ◽  
Hao Nguyen ◽  
Matthew R. Cooperberg ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Natural History ◽  
Locally Advanced ◽  
Specific Antigen ◽  
Salvage Treatment ◽  
Post Surgery ◽  
History Of

356 Background: Radical prostatectomy (RP) can provide good long-term oncological outcomes in patients with localized and locally advanced prostate cancer (PCa). After RP, prostate specific antigen (PSA) represents the corner stone for follow-up of patients. A persistently detectable PSA immediately following RP is an unfavourable prognostic factor. We described the natural history of the management and outcomes in men with a detectable PSA in an academic cohort. Methods: A retrospective review of prospectively collected clinical and pathologic data from consecutive patients who underwent RP for non-metastatic PCa between 2000 and 2018 was performed. A detectable PSA was defined as PSA ≥ 0.05 ng/ml between 2-6 months post-surgery. Biochemical recurrence (BCR) was defined as two consecutive PSA values ≥ 0.2 ng/ml after 6 months post-surgery or any salvage treatment for a rising PSA. Second recurrence was defined as additional treatment after post-RP salvage treatment. Outcomes were defined as time to other cause mortality (OCM) or prostate cancer specific mortality (PCSM). Results: We identified 499 men with a detectable PSA within 6 months following RP. Median PSA at diagnosis was 7.95 ng/ml (IQR 5.57-12.97). Median CAPRA-S score was 5 (IQR 2-7). Median follow-up was 41 months (IQR 20-77). 296 (59%) underwent salvage treatment for a rising PSA at a median of 5 months. 33 (23%) of these men required further treatment (10 for bone metastases) at a median of 7 months. 203 (41%) of men with an immediately detectable PSA did not undergo any further treatment after RP. Treatment-free survival after post-RP salvage (31 on ADT and 2 underwent salvage RT) in men with a detectable vs undetectable PSA was 86% vs 92% at 1 year, 78% vs 89% at 3 years, 72% vs 86% at 5 years and 70% vs 76% at 10 years (Log-rank p =0.02). Prostate cancer specific survival in men with a detectable vs undetectable PSA was 100% vs 100% at 1 year, 99% vs 100% at 3 years, 96% vs 100% at 5 years and 91% vs 99% at 10 years (Log-rank p < 0.01). Conclusions: This report describes the natural history of the management and outcomes in men with a detectable PSA following RP. We demonstrate that men with a detectable PSA after RP may have excellent long-term outcomes.

scholarly journals Profile of Radiation Therapy after Radical Prostatectomy: Experience in a Tertiary Hospital in Jakarta, Indonesia

2020 ◽  
Vol 14 (1) ◽  
pp. 16
Author(s):  
Rama Firmanto ◽  
Agus Rizal AH Hamid ◽  
Chaidir Arif Mochtar ◽  
Rainy Umbas
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Adjuvant Radiotherapy ◽  
Clinical Stage ◽  
Survival Rates ◽  
Specific Antigen ◽  
Salvage Radiotherapy ◽  
Clinical Staging ◽  
High Recurrence Rate

Background: Despite the high recurrence rate, radical prostatectomy (RP) remains as a preferable surgical treatment of localized prostate cancer. Adjuvant radiotherapy (ART) and salvage radiotherapy (SRT) are available approaches in preventing biochemical progression after RP. We aim to investigate the use of radiotherapy, both ART and SRT, in those who underwent RP.Methods: We used a retrospective cohort study design, with samples recruited from prostate cancer patients who underwent RP between January 2008 and December 2016. Patients who had undergone RP at Cipto Mangunkusumo Hospital, Jakarta, Indonesia were included in the present study. More in detail, three and five subjects were treated with ART and SRT, respectively. We only included those who had a minimum of one year of follow-up. Variables including age, preoperative prostate-specific antigen (PSA), clinical staging, pathological staging, Gleason score, and death were recorded. We analyzed the overall survival time using the Kaplan-Meier method.Results: From 34 patients included in the study, 26 underwent RP alone, while 5 patients underwent adjuvant radiotherapy and 3 patients underwent salvage radiotherapy after RP. The mean ages in the three groups were 61.46 ± 5.76, 58.2 ± 4.86 and 62.67 ± 7.5, respectively. The preoperative PSA value was above 10 mg/dL in 61.5% in patients without RT, 100% in patients with ART after RP, and none in SRT. 17 (51.5%) out of 33 subjects were ≥T2 clinical stage and 24/30 (80%) subjects were ≥pT2. Timing for ART and SRT ranged from 1.07 to 6.3 and 5.27 to 21.43 months after RP, respectively. The 10-year survival rates were 84.6% in patients with RP alone, 80% in patients with ART+RP, and 66.7% in patients with SRT+RP. The average survivals of those who had RP alone as well as ART and SRT were 44.56 ± 32.64, 46.79 ± 24.02, and 71.71 ± 38.74 months.Conclusions: The average survival of those who received SRT is better than those who underwent ART and RP alone. Prospective studies with larger samples are needed to evaluate the efficacy of radiation therapy after radical prostatectomy. 

Efficacy and tolerance of salvage radiotherapy after radical prostatectomy, with emphasis on high-risk patients suited for adjuvant radiotherapy

2010 ◽  
Vol 97 (3) ◽  
pp. 467-473 ◽  
Author(s):  
Ruben G.H.M. Cremers ◽  
Emile N.J.T. van Lin ◽  
Wieneke L.J. Gerrits ◽  
Julia J. van Tol-Geerdink ◽  
Lambertus A.L.M. Kiemeney ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
Adjuvant Radiotherapy ◽  
Salvage Radiotherapy ◽  
High Risk Patients ◽  
Risk Patients

Whole pelvic irradiation for prostate cancer patients with a biochemical relapse following radical prostatectomy: The era of robot-assisted minimally invasive surgery.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 210-210
Author(s):  
Jae-Sung Kim ◽  
Hyun-Cheol Kang ◽  
Seok-Soo Byun ◽  
Sang Eun Lee
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
Specific Antigen ◽  
Biochemical Relapse ◽  
High Risk Patients ◽  
Prostate Bed ◽  
Psa Failure ◽  
Risk Patients ◽  
Gi Toxicity

210 Background: We hypothesized that the addition of whole pelvic radiotherapy (WPRT) might improve biochemical outcome in salvage radiotherapy (RT) for biochemical failure (BCF), especially in patients with postoperative high-risk features after radical prostatectomy (RP) being good candidates beneficial from WPRT. Methods: From August 2004 to April 2012, 180 patients who experienced BCF after RP were treated with salvage RT. The primary end point was the biochemical relapse-free survival (bRFS) defined as no prostate-specific antigen (PSA) failure and no additional salvage treatments. Patients were stratified into theee groups; prostate bed radiotherapy (PBRT) alone (n = 52), PBRT with hormone (n = 85), and WPRT with hormone (n = 43). The effects of WPRT combined with hormone was measured in the high-risk patients defined as pN1 stage or inadequate pelvic lymph node dissection (harvested lymph nodes number of less than four). Toxicity from treatment was recorded when genitourinary or gastrointestinal (GI) events occurred. Results: The median follow-up was 43 months (8 to 103 months). The independent predictors for poor bRFS were time to PSA failure less than or equal to 1 year, PSA at salvage greater than 1 ng/mL, PSA doubling time less than 6 months, and PBRT alone group. The risk of BCF after salvage RT was significantly higher in PBRT alone group in comparison to that of WPRT with hormone group (hazard ratio [HR], 3.9; 95% CI, 1.8-8.3, p <0.001), but the outcomes of PBRT with hormone was not statistically different from that of WPRT with hormone (p = 0.67). The advantage of WPRT and hormone over PBRT alone was only observed in the high-risk patients (HR, 5.7; 95% CI, 1.8-17.7, p = 0.003), and not in other patients (HR, 3.2; 95% CI, 0.7-14.9. p = 0.14). Patient treated with WPRT had more greater than or equal to grade 2 late GI toxicity than those having PBRT (17% vs. 5%, p= 0.01). Conclusions: Patients with postoperative high risk features could benefit from WPRT and hormone therapy for postoperative BCF. The additional toxicity by WPRT and long-term outcomes warrant further investigations.

Sign in / Sign up

Export Citation Format

Share Document